About the service: The Willows is a care home that provides residential care within five units. It is located in Barton Upon Humber. The service is registered to provide accommodation for up to 39 people who require nursing or personal care.

People’s experience of using this service: The plumbing and heating systems had been replaced apart from in one unit. This work was being undertaken. A separate dementia unit was about to be created to enhance the environment for people living with dementia. Infection prevention and control practices had been strengthened since the last inspection. Minor infection control issues found during the inspection were addressed. Medicine management had improved. However, staff were reminded not to leave medicines with people because they could be accessed by other people for whom the medicine was not prescribed.

The provider had failed to notify the Care Quality Commission about the absence of the registered manager. Timely action had not been taken to implement a recommendation made to improve the environment for people living with dementia. The replacement of the plumbing and heating system throughout the service had not yet been completed.

Safeguarding policies and procedures were in place to protect people from harm and abuse. Staffing levels were monitored to ensure people's needs were met consistently.

Staff received appropriate induction, training, and support and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

Where people had been assessed as at risk from any activity, their care records provided guidance for staff to provide safe care and support.

Where people were unable to consent to their care and support the provider followed appropriate legislation to make sure any decisions were in the persons best interest.

People living at the service told us they were satisfied with the service provided. Staff understood the importance of providing person-centred care and developed positive relationships with people. People received support and staff encouraged their independence to live without unnecessary restriction.

Caring staff supported people living at the service. People received information in an accessible way to enable them to understand what was available to them.

Staff were trained and their skills and knowledge checked through competency assessments. Staff asked healthcare professionals for advice, guidance and support about how to meet people’s needs. People’s independence was promoted and encouraged. People’s dietary needs were met. End of life care was provided at the service. Concerns and complaints raised were dealt with appropriately.

The provider used a range of audits to check quality and safety at the service. These quality checks had been and were being improved to prevent further shortfalls occurring. For example, a laundry room audit was implemented during the inspection. Community links were being promoted. People and relatives had the opportunity to provide feedback about the service. Data security was maintained.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published on 23 March 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

The inspection took place on 25 January and 6 February 2018.

At the last inspection of this service in December 2016 we rated this service as requires improvement in safe and well-led, which meant the quality rating of the service was requires improvement overall. There were no breaches of legal requirements.

At this inspection we looked to see if the required improvements had been made. We found the shortfalls found with the toilet and bathrooms at the last inspection had been addressed, however other shortfalls were found with the environment, infection control and medicine management and quality monitoring of the service. However we found the service was not always well-led and infection control and medicine management was not monitored effectively. The environment and heating systems at the service were also not well maintained. There was a breach of Regulation 17, Good Governance and Regulation 15, Premises and equipment of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

The Willows is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 39 people across three separate units, each of which have separate facilities. The service provides care and support to people living with dementia. At the time of our inspection there were 18 people using the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were issues with infection control, some of the issues were addressed at the time of the inspection. We recommend infection control is made more robust at the service.

We also found medicine management required improving in regard to the secure storage of medicine and in relation to the administration and recording of people's prescribed creams and ointments. We recommend medicine management is made more robust at the service.

We found staff were aware of how to report potential harm and abuse. This helped to protect people. Accidents and incidents were monitored and there was a robust recruitment process in place.

The environment in some areas was found to require enhancing to help support people living with dementia. Some areas of the service were decorated in bland colours with no highlighted features such as hand rails or bedrooms doors which may help people see them. There were highly patterned carpets in some areas which may confuse people living with dementia.

We recommend good practice guidance for dementia friendly environments is followed at the service.

Staffing levels provided were adequate to meet people's needs during our inspection. Staff undertook training and supervision. However, appraisals were not up to date and these were just being scheduled for staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were treated with kindness and patience by staff and their privacy and dignity was respected. Advocates were available, if required to help people to raise their views.

A balanced diet was provided to people to ensure their dietary needs were met. People who required assistance to eat and drink were supported by attentive staff. Health care professionals supported people appropriately and help and advice was sought by staff in a timely

The Willows care home is registered to provide accommodation for up to 39 people who require nursing or personal care, some of whom may be living with dementia. The home is a single storey service, divided into five units with various seating and dining areas and is located close to the centre of Barton Upon Humber. On the day of the inspection there were 23 people using the service.

We undertook this unannounced inspection on the 19 December 2016. At the last inspection on the 19 and 26 August 2015 we found a breach in regulation, which related to the operation of governance systems and auditing processes, and the availability of accurate and detailed records. The overall rating for the service was, “Requires improvement”. Following the inspection in August 2015 we received an action plan from the registered provider detailing how improvements would be made including a timescale.

The service had a registered manager in post who was also the registered provider. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found improvements had been made in regard to the continual evaluation of the actions required to improve the service and the accuracy and detail of records. The registered provider had made improvements in the way the service organised information and a programme of audits were in place to enable to the quality of the service to be monitored. An analysis of accidents and incidents was undertaken on a monthly basis to identify any trends or patterns.

At the last inspection we made a recommendation for the registered provider to find out more in relation to providing activities and meaningful occupation for people living with dementia. During this inspection we saw people were encouraged to take part in various activities if they wished to do so.

We found the service required improvements to two out of the five key areas at this inspection. We noted a number of maintenance issues that required attention at the service. These included toilet floorings lifting in areas, badly stained/marked toilets, plaster coming off wall and a cracked sink. We saw that two of the bathrooms had storage cabinets, which contained personal hygiene products, which should have been stored in the rooms of people who used the service to prevent cross contamination.

Staff understood the principles and processes of safeguarding vulnerable people and had received training to support them. People living at the service said they felt safe and told us that staff were good and caring. We found that medicines were stored and administered appropriately in line with current guidance. Staff had been recruited safely and appropriate checks were completed prior to them starting work at The Willows. Staff had good knowledge and an understanding of the needs of the people who used the service.

Plans were in place for emergencies like a fire or a flood and staff knew what to do in the event of an emergency. Safety equipment, electrical appliances and gas safety were all checked regularly.

The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) although no applications had been submitted in respect of people being deprived of their liberty because this was not needed at the time of this inspection. The Mental Capacity Act 2005 (MCA) legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person's best interest and are least restrictive.

We observed that staff spoke to people positively and treated them with respect. Staff and people who used the service interacted in a friendly way and observations showed good relationships existed between them.

People who used the service had

We observed staff involved people in decisions about their support and talked with them about their wishes and feelings, to ensure their needs were respected. People told us that staff looked after them well and provided friendly encouragement and support where this was required. They told us that overall they were happy with the service provided.

We saw that people looked comfortable, well cared for and that staff interacted with them in a friendly and compassionate manner. People told us that staff listened to them and obtained medical assistance when this was needed. People told us that staff were helpful and “Very kind.”

We observed staff interacted with people in an open and friendly way. People told us they were comfortable and felt safe in the home. People said they had “No complaints” and would talk to staff in they had any concerns. There was evidence staff completed safeguarding training to ensure they were able to recognise and act on potential issues of abuse of people if this was required.

We found the home was warm, clean and well maintained. We saw a range of equipment was available such as walking aids and hoists, to enable peoples’ personal dignity, independence and wellbeing to be promoted.

We found policies and procedures were followed for checking that staff were safe to work with people who used the service.

There were systems in place to enable the health, welfare and safety of people who used the service to be monitored by the provider. We saw letters of appreciation that had been recently received by the service.

We observed staff displayed an open and friendly approach and involved people in decisions and choices about their support. We saw staff talking kindly with people and observed they engaged positively with people, to ensure their individual needs were met. People told us that staff respected their wishes and feelings and were “Kind and helpful.”

We found there was a warm and friendly atmosphere throughout the home. We observed that people looked clean and well cared for and saw that the home was neat and tidy, with no unpleasant smells. Relatives we spoke with were very positive about the home, whilst a visiting district nurse told us they had “No concerns” and were happy with service provided.

People told us that overall, they were happy with the standard of food that was served. We saw evidence of consultation with people about choices and suggestions for meals that were provided.

People who used the service told us they were “Satisfied” and “Confident" that any concerns would be properly dealt with. People told us they felt safe using the service.

Staff told us they enjoyed their work and we saw they worked effectively and efficiently as a team. We found that a programme of training was available to enable staff to undertake nationally recognised qualifications. People that used the service told us that staff were “Fabulous.”

We saw that systems were in place to enable the quality of the service to be monitored by the provider.

People told us they liked living at this location and were happy with the standard of care being delivered and their own bedroom areas. They told us they had enough to eat each day and there were choices of food at each meal time. People described how kind, respectful and polite staff are to them and felt confident they could approach any staff member and the manager if they had any concerns.

This inspection took place on 19 and 26 August 2015 and was unannounced. The service was last inspected on 17 January 2013 when it was found to be compliant with the regulations inspected.

The Willows care home is situated in a quiet cul-de-sac close to the centre of Barton-upon-Humber. The home is a single storey building divided into five units. It has a number of sitting and dining areas. There is a secure patio enclosure and a lawned garden area. All parts of the service are accessible to wheelchair users. The service is registered to provide accommodation for up to 39 people who require nursing or personal care, some of whom may be living with dementia.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were familiar with roles and responsibilities for reporting safeguarding or whistleblowing concerns. Staff had received training about the protection of vulnerable adults from harm or abuse.

Appropriate recruitment checks were carried out on new staff before they were allowed to start work to ensure they were safe to work with people who used the service.

A variety of training had been provided to ensure staff were able to safely carry out their roles. Staff had received supervision and appraisals of their skills to ensure their performance was monitored and they were able to develop their careers.

Staff had received training on the Mental Capacity Act and the Deprivation of Liberty Safeguards to ensure people were supported to make informed choices and enable their human rights to be upheld.

Details about known risks to people were recorded and monitored, together with guidance for staff on how these were safely managed.

Staff demonstrated a good understanding of the promotion of people’s personal dignity and privacy, whilst involving them in making active choices about their lives.

Systems were in place to ensure people’s medication was handled safely.

People were able to make choices from a variety of wholesome and nutritious meals. Assessments about people’s nutritional needs and associated risks were monitored with the involved specialist health care professionals when required.

A complaints procedure was available to enable people knew how to raise concerns about the service. People’s complaints were followed up and addressed and wherever possible resolved.

There were limited opportunities available, for people to engage in meaningful activities.

Whilst systems and processes were in place to measure the quality of the service, these had sometimes failed to identify and continually evaluate the actions required to improve the service.

You can see what action we told the registered provider to take at the back of the full version of the report.